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| Sunday, 22 August 2004 |
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| News Business Features Editorial
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Compiled by Carol Aloysius Are you an air swallower ? "Hippocrates once professed that passing gas is necessary for one's well- being" Each one of us suffer from gas in the digestive system (Aerophagin), at one time or the other. Gas is eliminated by belching or passing it through the rectum. Most people think they have too much gas in their digestive system, that is in the (oesophagus stomach small intestine and large intestine), when they really have normal amounts. Gas is uncomfortable and embarrassing but never life threatening, says DR. RANI GOONEWARDENE in conversation with CAROL ALOYSIUS. Q: When do people complain of gas? A: When they have belching air from the stomach after meals; Bloating of the abdomen after eating: Pain in the abdomen or: Frequent passing of flatus/gas from the rectum. Q: What causes gas? A: Gas comes from two sources: Swallowed air: Normal break down of undigested foods by harmless bacteria naturally present in the large intestine (colon). If doctors suspect that the gas is produced due to an illness further tests will be done to diagnose it. Q: When do we swallow air? A: Small amounts when eating and drinking: Large amounts when rapidly eating, drinking, chewing gum, loose dentures and when reclining after meals: During stress, when one tends to breathe heavily, (hyperventilating) and taking a deep sigh: Also in cases of obsessive compulsive disorder swallow excessive gas. Q: What tips can you offer to help reduce air swallowing ? A: Eat smaller, more frequent meals. Eat slowly. Avoid overeating. Do not talk while eating. Drink out of cups and glasses, not cans and bottles. Sip fluids-don't gulp. Avoid drinking through a straw. Avoid Mints chocolates, onions and tomatoes that relax the muscle at the lower end of the oesophagus and allow the air to escape from the stomach by belching. Reduce your intake of beer and carbonated beverages. Do not deliberately swallow air to belch. Eliminate or cut down on smoking, gum chewing, chewing a cigar, sucking on candy and all other habits that promote air swallowing. Tight clothing increases the pressure on the abdomen which can obstruct smooth air passage resulting in belching. Q: How do we get rid of swallowed air? A: By belching: This is the act of expelling the gas in the stomach through the mouth. Swallowed air causes distension of the stomach and is relieved by belching. Everybody belches after food infrequently. Q: Why do some people belch more frequently than others ? A: Because of excess air swallowing, and releasing it before it reaches the stomach by forcing it up the wind pipe as a belch. At times people belch as a habit, without excess air in the stomach. Others belch to relieve any type of discomfort in the stomach. If you are an excess air swallower you may be producing excess saliva that needs frequent swallowing. Q: Are there any other more serious causes for belching ? A: Sometimes a person with chronic belching may suffer from peptic ulcer disease. Gastro oesophageal disease (GERD), or gas bloat syndrome after GERD surgery. But if the abdominal discomfort is not relieved by belching then further investigations are necessary to determine the cause. In meagonblase syndrome there is chronic belching characterised by severe air swallowing, and an enlarged bubble of gas in the stomach after heavy meals. It mimics a heart attack with shortness of breath and fullness of abdomen. Part of the air that is swallowed goes down and it is absorbed in the small intestine. The remaining is passed into the large intestine and passed out as flatus. Q: Some people complain of 'bloated' stomachs. What is this condition ? A: Bloating is a subjective feeling (sensation) that the abdomen is larger than normal. It is a symptom and may precede the sign of abdominal distension which is an objective determination that the abdomen is larger than normal. Q: What causes it ? A: Break down of certain foods by harmless bacteria in the large intestine producing gas. Q: Is abdominal pain due to gas ? A: Some people will have pain in the intestines when they have gas. If the pain is on the left side of the abdomen it can mimic a heart attack, and on the right side mimic gall stones or appendicitis. Q: Flatulence is often linked with gas. Tell us about this condition ? A: Flatulence is having excess gas in the stomach or intestine resulting in belching and bloating, and passing flatus (which is the passage of gas through the rectum/anus.) Q: What causes flatulence ? Is swallowed air a cause ? A: Very rarely swallowed air cause flatulence. The usual source is the excessive production of gas by the bacteria found in the colon when they digest sugars and polysaccharides. Excessive production of gas or flatulence is caused by some bacteria, mal -digestion, mal- absorption of some foods, and overgrowth of some bacteria. Q: What foods are not absorbed or digested in the small intestine ? A: Certain carbohydrates (sugars, (lactose intolerance) starches, and fibre) these are broken down by bacteria in the large intestine producing gas. Fats and proteins produce less gas. Q: Name some of these foods? A: Legumes: dried beans and peas, baked beans, gram soy beans, lima beans: Milk products: milk, ice cream, cheese: Vegetables: cabbage, radishes, onions, broccoli, brussels sprouts, cauliflower, cucumbers, asparagus, Root vegetables: potatoes, turnips.Fruits include prunes, apricots, apples, raisins, bananas. Other foods include Cereals and Breads: cereals, breads, pastries, and all foods containing wheat and wheat products. Fatty foods: pan-fried or deep-fried foods, fatty meats, rich cream sauces and gravies, pastries, and any high-fat food, as well as Liquids: carbonated. Q: What is gas made up of ? A: Hydrogen, Oxygen, Carbon-dioxide and in one third of people methane which are released through the rectum... Q: What is the normal amount of gas a person produces? A: Most people produce about 1 to 4 pints a day/and pass gas about 14 times a day. Q: What is the unpleasant smell of gas/flatulence due to ? A: The undigested food in the intestine is broken down by bacteria releasing small amounts of Sulfur, containing compounds Indole and skatole. Q: how can one prevent gas in the digestive system ? A: Belching, bloating and flatulence are difficult to relieve as it is due to unconscious aerophagia. It may also be due to an enhanced sensitivity to swallowed air. since aerophagia is due to excess salivation: Avoid habits like gum chewing, smoking. Treat diseases like peptic ulcers that cause salivation, as well as disorders that may cause nausea and reflex salivation. When aerophagia is troublesome, clamping a pencil or other object between the teeth may decrease the amount of involuntary or habit swallowing. As air cannot be swallowed when the jaws are separated. Psychological treatments such as relaxation therapy or behavioral therapy are currently the most useful approaches. Changing the diet and maintaining a food diary to eliminate gas producing foods, can also help. Q: What about medication ? A: Non prescriptive over-the-counter medicines like antacids with simethicone which is a foaming gel and this joins the gas bubble in the stomach will help to eliminate the gas easily by belching. But it will have no effect on the gas in the intestine. Digestive enzymes with lactase to improve the digestion of carbohydrates may help. This will allow them to eat carbohydrates that normally cause gas. Reducing air swallowing can also reduce (aerophagin) or gas in the digestive system. **************** Test to diagnose heart attacks by Dr. D. P. Atukorale
In the majority of patients with chest pain, the clinical history and the electrocardiogram (E.C.G.) provides sufficient information to the physician treating heart patients. However for confirmation of the diagnosis of myocardial infarction (MI), the physicians have to depend on certain biochemical tests such as (a) Cardiac enzymes e.g. CK and CK (MB) and (b) Troponin test (Troponin T or Troponin I) to confirm the diagnosis of ML. If the first set of tests yields a negative report, the test has to be repeated in about 4 hours when it is usually positive. A new cardiac test known as Rapid Cardiac Panel Test which has been recently introduced into the private sector as a screening test to select patients for admission to Coronary Intensive Care Units (CCUs) consists of three parameters (a) Cardiac troponin I test (b) CK (MB) and (c) blood myoglobin.
The ICU is the best place for a MI patient to get a cardiac arrest (ventricular fibrillation and cardiac asystole) as the nursing staff in an ICU are specially trained in resuscitating MI patient who get cardiac arrest. The Cardiac Panel Test has been approved by FDA and is widely used by medical officers attached to out patients department (OPD) in USA, as a screening test for patients with chest pain. If the test is positive, even if the ECG is normal, these patients can be admitted to CCU for observation. It is noteworthy that some medical officers working in the OPD gives OPD treatment with antacids and pain killers to heart attack patients with normal ECG. Some of these unfortunate patients sometimes die at home and others get readmitted to hospital with complicated heart attacks in one or two days. Thus unnecessary mortality and morbidity can be prevented if the Cardiac Panel Test is introduced to our hospitals. ***** Vitamins that can prevent heart attacks It is common knowledge that smoking, hypercholesterolaemia, hypertension, diabetes, obesity lack of exercise and stress are risk factors for heart attacks. Another risk factor for heart attacks which is not well known is hyperhomocysteinaemia (high serum levels of homocysteine) Homocysteine is an aminoacid normally present in our blood and high serum levels of homocysteine is responsible for a number of diseases. Hyperhomocysteinaemia is an established coronary risk factor especially in the young coronary artery disease patients and doctors have been prescribing folic acid (which is one of the B - complex vitamins) and vitamin B 12 to treat patients with coronary artery disease. Until recently doctors were not aware of the exact mechanism of action by which lowering of serum homocysteine by folic acid and B 12 helped coronary patients. In the August 2002 issue of the Journal of the American College of Cardiology Dr. Frank F. Willems et al have proved, using double blind controlled trials, that lowering serum levels of homocysteine improved the endothelial function thus reducing risk of getting heart attacks. Folic acid (5mg per day) reduced the serum homocysteine level by 25 percent whereas vitamin B 12 reduced the homocysteine level by 7 percent thus out of the two vitamins, folic acid is better. Ideally serum homocysteine level has to be estimated before and after treatment with the vitamins; but facilities for estimation of serum homocysteine are not available in the government hospitals of Sri Lanka. In the private sector, it costs about Rs. 1000 for estimation of serum homocysteine levels. Folic acid is one of the cheapest vitamins and cost of a 5mg tablet (which is the daily dose) is only 14 cents Folic acid in a dosage of 5mg does not cause any side effects. Some of the general physicians and cardiologists have been prescribing this vitamin to all ischaemic heart disease patients for some time. Folic acid can be bought from any chemist without a doctors prescription. It is advisable for all physicians to prescribe this very useful vitamin to all coronary artery disease patients and those who are predisposed to coronary artery disease with a view to reduce the incidence of heart attacks in the community. **************** Good news for Diabetic patients The Ceylinco Diabetes Centre has acquired the latest Non-Mydriatic Retinal Camera for its Eye Clinic, enabling visitors afflicted with diabetes to have the insides of their eyes examined for changes and photographed for future reference. The camera, also known as a Fundus Photography Machine, was supplied by TOPCON of Japan, one of the world's leading manufacturers of ophthalmic equipment, the Centre said this week. "Fundus photography is an important enhancement to slit lamp examination of the retina, because it allows doctors to keep a visual record of changes that take place as a result of diabetes," Dr. Samanthi de Silva, Senior Medical Officer of Ceylinco Healthcare Services Ltd., (CHSL) the company that owns and operates the Diabetes Centre, states in a press release. "The Retinal Camera enables a doctor to examine a patient's inner eye for ruptured blood vessels and the resultant bleeding and scarring that takes place even before the patient experiences an impairment of vision, making early treatment possible. The image is stored in a computer and can be printed in colour, providing the patient with a photograph of his or her retina which can be interpreted by any doctor." Periodic eye checks are mandatory for diabetics, she adds. "Most diabetics tend to forget this because the complications become apparent only in late stages and are often blamed on age." She states that vision-related problems caused by diabetes set in without any early warning symptoms. Fragile blood vessels can rupture and bleed causing blindness if not treated early. There can be a significant impairment of vision if the best focusing area of the retina, called the macula, is affected. This could happen as much as 10 years after the onset of diabetes but certain people could have eye complications at the time of diagnosis. Therefore, it has become mandatory for all diabetics to undergo eye checks at least once a year. The Ceylinco Diabetes Centre's Eye Clinic is also equipped for slit lamp examination, eye pressure testing and checking for refractory errors by a team of consultant ophthalmologists. |
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Early diagnosis of myocardial infarction (Heart Attack) is essential to
allow prompt intervention with specific treatment e.g. with thrombolytic
drugs such as Streptokinase to limit damage to heart muscle and to reduce
cardiac mortality and morbidity.
The Rapid Cardiac Panel Test helps in the early diagnosis and
confirmation of heart attacks (MI). Early diagnosis of MI helps the
physician to reduce cardiac morbidity and mortality by transferring the
angina patients with positive cardiac enzymes and Troponin test to
Intensive Care Unit (ICU) and giving clot dissolving thrombolytic drugs.
